Population Action International celebrated an important victory for women and their families last week, as Congress passed a Foreign Operations Appropriations bill (H.R. 2764 ) that contained language correcting some of the most egregious aspects of U.S. international sexual and reproductive health policy.

 

Despite attacks by family planning and reproductive health opponents, two important provisions survived:

• An amendment put forth by Foreign Operations Chairwoman Nita Lowey (D-NY) that exempts overseas NGO family planning providers from the restrictions of the Global Gag Rule (Mexico City Policy) that cuts off the flow of U.S.-donated contraceptives and condoms.

• A provision that repeals the abstinence-only funding restrictions under PEPFAR (the President’s Emergency Plan for AIDS Relief) that require at least one-third of all U.S. HIV/AIDS prevention funding be limited to abstinence programs.

 

Three amendments that came up on the House floor were vigorously debated: the aforementioned Lowey Amendment,  the Smith-Stupak Amendment that would have nullified the Lowey Amendment, and the Pitts Amendment that would have preserved the abstinence funding restriction.

 

Some of the most powerful statements on the House floor came from Members who identify themselves as anti-abortion but understand that these changes in U.S. policy would help prevent abortion and the transmission of sexually transmitted infections, including HIV/AIDS. Both provisions were upheld with support from both Democrats and Republicans, including some Members who in the past have not been as supportive.

 

President Bush has vowed to veto the entire $34.2 billion foreign assistance spending bill over the new contraceptives language. This week, the Senate is expected to begin work on its version of the appropriations bill.  Indications are that they will include similar provisions on the Gag Rule and HIV/AIDS. Once the Senate completes its work on the bill in July, the bill will then go to a conference committee.  There, the House and Senate versions will be reconciled and sent to the President for his approval or veto.

 

So while there are still hurdles to overcome before these provisions can become law, we are celebrating this victory for women and their families around the world. It is a long overdue and much needed dose of common sense when it comes to U.S. assistance on family planning and HIV/AIDS.

Family planning and reproductive health supporters are on the verge of a very important show-down in the House of Representatives on the issues of access to contraceptives and abstinence-only HIV/AIDS prevention restrictions.  As early as Wednesday, June 20th, the full House may begin floor debate on the FY 2008 State-foreign operations appropriations bill, which includes the following breakthrough provisions:

• an exemption from the Global Gag Rule/Mexico City Policy (GGR) for contraceptives and condoms allowing foreign organizations otherwise ineligible for U.S.  assistance under the GGR to receive U.S. government-donated contraceptives and condoms; and
• a provision that nullifies the earmark that requires that at least one-third of bilateral HIV/AIDS prevention funding be spent on  "abstinence-until-marriage" programs.

 

In addition, the bill provides $441 million for family planning and reproductive health programs, a very slight increase over current levels but a $116 million increase above the President’s request.  The bill also furnishes a U.S. contribution of $40 million to the UN Population Fund, subject to long-standing Kemp-Kasten restrictions that has allowed President Bush to withhold U.S. funding to UNFPA for the last five years. However, new language in the bill seeks to ensure a more thorough and transparent review by the President in making his determination on whether or not to fund UNFPA.

 

Not everyone is excited about these potential policy improvements, however.  The Global Gag Rule puts women at increased risk of unintended pregnancy due to lack of modern contraceptives and services.  If clinic shelves are empty, how can women and their partners achieve their stated goal of planning their families?

 

Since the reinstatement of the Global Gag Rule in 2001, shipments of contraceptives have been stopped to 20 developing countries – a tragic consequence of a misguided policy.  In Ethiopia, clinics immediately fell short of condoms and contraceptives after passage of the Global Gag Rule.  They appealed to the government for help, but supply shipments were inconsistent and couldn’t keep up with demand.  Currently, 1 in every 14 Ethiopian women will die of pregnancy-related causes—and many of these women had not planned to become pregnant in the first place.  In Ghana, the Global Gag Rule resulted in a loss of contraceptives and funding for community health workers.  As a result, the Planned Parenthood Association of Ghana (PPAG) began treating nearly twice as many women for complications from unsafe abortion as they had the previous year, before the Gag Rule had been reinstated.  That doesn’t sound like a policy that is preventing abortion – let alone improving reproductive health in these countries.

 

Members of Congress should oppose efforts to remove the contraceptive provision and should support overturning the abstinence-only earmark, thereby demonstrating their commitment to reducing unintended pregnancies, reducing abortion, and preventing sexually transmitted infections, including HIV/AIDS. 

 

For most American women and men on both sides of the abortion debate, access to contraceptives is a basic human right. Why should that be any different for the millions of women and men in the developing world?

 With its Subcommittee on State, Foreign Operations and Related Programs’ approval of the fiscal year 2008 appropriations bill, the House of Representatives took a significant step toward grounding U.S. aid for family planning and HIV/AIDS relief in sound evidence.  The appropriations bill contains several important family planning and reproductive health provisions, including: (1) granting the president the authority to waive the abstinence-until-marriage earmark under PEPFAR that requires at least one-third of U.S. HIV/AIDS prevention funding be limited to abstinence-until-marriage programs; and (2) an exemption of U.S. contraceptives shipments to the developing world from the restrictions of the Global Gag Rule .  PAI urges Congress to approve these important changes to the destructive reproductive health policies of the Bush Administration. 

The House bill provides an overall funding level of $441 million for U.S. international family planning and reproductive health programs through the U.S. Agency for International Development (USAID).  This represents a $116 million increase above the President’s request but only a slight increase over current levels.  The bill also includes $40 million for the United Nations Population Fund (UNFPA), subject to existing Kemp-Kasten restrictions, but it requires more detailed reporting by the Bush Administration in the event that it again invokes Kemp-Kasten and withholds funds from UNFPA.  In addition, any funds withheld from UNFPA would have to be reprogrammed to bilateral Family Planning/Reproductive Health activities through USAID. 

 

Overturning the abstinence-until-marriage earmark in PEPFAR would make the program more effective in curbing the spread of HIV/AIDS.  According to two congressionally mandated studies on the effectiveness of PEPFAR – from the Government Accountability Office (GAO) and the National Institute of Medicine (IOM) – this spending requirement undermines U.S. efforts to prevent new HIV infections by hindering the development of comprehensive, integrated HIV prevention programs that address vulnerabilities unique to local populations. 

 

The contraceptives provision will be crucial to meeting the ever rising demand for and shortages of contraceptives in developing nations. Since the Global Gag Rule was reinstated by President Bush in 2001, shipments of U.S.-donated contraceptives have been stopped to 20 developing countries in Africa, Asia and the Middle East.  Increasing U.S. donations of contraceptives and condoms is essential to reducing unintended pregnancies, abortion and sexually transmitted infections such as HIV/AIDS.  Filling the unmet need for contraceptives would avert 52 million unwanted pregnancies each year, preventing an estimated 29 million abortions, 142,000 pregnancy-related deaths – and 505,000 children from losing their mothers.

 

The full Appropriations Committee will vote on June 12th, and the bill is scheduled to move quickly to the House Floor the week of June 18th.   Congress has the opportunity to save tens of thousands of lives and improve the quality of life for countless more women and children.  The House bill is a good start to ensuring that reproductive health policies – including those that address HIV prevention – are grounded in evidence and address the needs of women and their families.

PAI was thrilled to hear President Bush announce last week that he is requesting an additional 30 billion in funding for the President’s Emergency Plan for AIDS Relief (PEPFAR) over the next five years.  This historic effort has enormous potential to save millions of lives.

To be successful, PEPFAR must coordinate with family planning and reproductive health programs, which should be fully funded—and not become a casualty of these laudable efforts to combat HIV.  And misguided policies—if allowed to continue uncorrected—are PEPFAR's fatal flaw.  For example, PEPFAR’s current prevention efforts are stymied by a spending requirement that forces one-third of all prevention funding into “abstinence-until-marriage” programs.  Only by overturning this one-size-fits-all prescription can PEPFAR live up to its potential to curb the spread of this epidemic. This is just one of the policies that need to be addressed as we move into the next phase of the U.S. response to the global AIDS pandemic.

PAI’s Vice President for Public Policy Terri Bartlett responded to President Bush’s announcement: “We welcome this news and urge Congress to take up the challenge but to take the opportunity to make PEPFAR much more effective by correcting policies on the basis of evidence, not ideology.”  By overturning the “abstinence-until-marriage” spending constraint, PEPFAR recipient "focus countries" will be better able to target how HIV/AIDS is striking their particular local populations and meet their evolving needs to protect themselves from this epidemic.

PEPFAR currently provides live-saving treatment to approximately 1.4 million people, a number that is projected to increase to 2.5 million people with this increase in funding.  However, even more lives can be saved if these treatment programs are combined with comprehensive, evidence-based prevention policies and work in concert with existing—and future—family planning and reproductive health programs.

As Congress reviews PEPFAR and prepares to take up its reauthorization, we urge them to take the time to really review the program’s prevention policies to ensure that people have access to the quality education, services and supplies necessary to protect themselves.  We have the opportunity to stop HIV/AIDS in its tracks; let's not waste it.